How Was Your Day?

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Please take a few minutes before the end of your shift to fill out this questionnaire to help us improve or maintain our performance at this location. All comments are confidential. Thank you for your cooperation and input.

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Your Name:* This field is required.

LAST NAME, FIRST NAME

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Date:* This field is required.

Date

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Position:* This field is required.

I am a Behaviour Interventionist (BI)

I am a Community Care Worker (CCW previously RCW)

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Service Unit (location):* This field is required.

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Shift:* This field is required.

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Caregiver(s) you worked with:* This field is required.

Full name(s)

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1. Were you greeted warmly by all staff working when you came in?

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2. Were you introduced to those you may not have met yet (staff and clients)?

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3. Were the staff helpful? Explained routine, shift duties, etc?

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4. Were you asked throughout the shift if you required any help?

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5. Did you get help/direction when/if you asked the person you were working with?

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6. Did you feel included or part of the TEAM? Please give examples.

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7. How would you describe overall your shift today?

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8. How would you describe overall the environment of the home today? Please explain contributing factors.

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Team Leader was made aware of my negative experience. Do you feel your concerns were addressed by the TL?* This field is required.

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Get Page URL

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Follow up notes - if required

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